Breast Flashcards
When is fibrocystic change most common?
premenopausal females
- 20 -50 years old
What are 2 major subtypes of fibrocystic change?
- What are the features of each?
Sclerosing adenosis
- Acini and stromal fibrosis, associated w. calcifications
Epithelial hyperplasia
- Cells in terminal ductal or lobular epithelium
What subtype of fibrocystic change disease is more likely to result in cancer?
Epithelial hyperplasia (incr risk of carcinoma w. atypical cells) - Sclerosing adenosis, slight incr risk
What are the 2 types of inflammatory benign breast diseases?
- Fat necrosis
- Lactational mastitis
What will fat necrosis show on mammography and biopsy?
Mammography - calcified oil cyst
Biopsy - Necrotic fat and giant cells
Giant oily block of cheese
What are the the benign tumours which affect the breast?
- Fibroadenoma
- Intraductal papilloma
- Phyllodes tumour
What ducts are affected in Intraductal papilloma, mastitis/abcess, paget disease?
Lactiferous duct and Major duct (distal)
DCIS + carcinoma, LCIS + carcinoma and fibrocystic change affect what ducts?
Terminal duct and lobular unit (proximal)
What breast diseases affect the stroma?
- Fibroadenoma
- Phyllodes tumor
Sclerosing adenosis affects acini and stroma
When is fibroadenoma most common?
< 35 years old
What bacteria causes lactational mastitis?
S. aureus - come thru cracks in nipple
What percentage of those with fat necrosis report trauma?
50%
Who is most commonly affected by fibroadenoma?
< 35years old
Describe the features of a fibroadenoma presentation
Small, well-defined, mobile mass in < 35 year old female
- Increased size and tenderness with incr estrogen
What benign tumours are associated with cancer what is less so?
- Fibroadenoma = not increased risk
- Intraductal papilloma = slight increase
- Phyllodes tumour = Some may become malignant
What is fibroadenoma (benign tumour) composed of?
Fibrous tissue and glands
What is the most common cause of nipple discharge serous or bloody?
Intraductal papilloma
Describe Intraductal papilloma (benign tumor)
Small fibroepithelial tumour w. lactiferous ducts typically beneath areola
Describe Phyllodes tumour (histo)
Large mass of connective tissue (stroma) and cysts with ‘leaf-like’ lobulations
Who is most commonly affected by Phyllodes tumour?
Woman in 40s
What quarter of the breast is most commonly affected by breast cancer?
Upper outer
What are the receptors which can be amplified/overexpressed in breast cancer?
- Estrogen receptor
- Progesterone receptor
- c-erB2, HER2 - an Epidermal Growth Factor Receptor (EGFR)
What type of breast cancer is most aggressive in terms of receptors?
Triple negative
How is DCIS usually detected?
Macrocalcifications on mammography
- Usually does not produce a mass
What is Comedocarcinoma, what is it a subtype of? What is seen on histology?
A subtype of DCIS
- Cells have high-grade nuclei w. extensive central necrosis and dystrophic calcification
What is seen on histology in DCIS?
Cells filling ductal lumen, neoplastic cells that engorge blood vessel
- Arises from ductal atypia
What is the most common type of invasive breast cancer?
Invasive ductal carcinoma
What is the pathophysiology of Paget’s disease?
Extension of underlying DCIS/invasive breast cancer up to lactiferous duct ands and into contigous skin of nipple from terminal duct/lobular unit
What will Paget’s disease look like?
Eczematous patches over nipple and areolar skin
Lobular carcinomas / LCIS lack what molecule?
E-cadherin
What does a lack of E-cadherin result in in histology in Lobular carcinomas / LCIS?
Orderly row of cells ‘single file’ and no duct formation
- Lines of cells
- Often bilateral w. multiple lesions in the same location
What response do invasive lobular carcinoma lack?
Desmoplastic response
What can a medullary carcinoma mimic?
A well-circumscribed tumour can mimic fibroadenoma
What will be seen on histology in medullary carcinoma?
Large, anaplastic cells growing in sheets w. associated lymphocytes and plasma cells
Describe Inflammatory breast cancer
Dermal lymphatic space invasion -> breast pain w. warm, swollen, erythematous skin around exaggerated hair follicles (peau d’orange’)
What type of breast cancer can lack a palpable mass?
Inflammatory
Name the ducts of the breast from the nipple to the lobular units
Lactiferous duct -> Major duct -> Terminal duct
-> Lobular unit (surrounded by stroma)
What is a stereotypical presentation of fibrocystic change disease?
Premenopausal woman 20-50
- Premenstrual breast pain or lumps
Describe invasive ductal carcinoma?
- Firm, fibrous “rock-hard” mass with sharp margins and - Small, glandular, duct-like cells in desmoplastic stroma
Differences between invasive ductal and invasive lobular?
- Lobular does not have ducts
- Lobular has decreased E-cadherin, single-file orderly row of cells
- Lobular lacks desmoplastic response
